Effect Measure

Children’s health and tobacco

DemFromCT continues his public health series over at DailyKos, thus also continuing to make my early week blogging easier. This week is a brief look at this year’s flu season, already in full swing, including what is happening in pediatric deaths from flu. He follows this with another interview, this time the American Lung Association’s Director, National Advocacy, Erika Sward. Topics are timely: SCHIP (the Children’s Health Insurance bill, just signed into law) and tobacco control.

These topics are intimately connected. Children are harmed by second hand smoke and are the next generation of nicotine addicts. And SCHIP is funded by a fairly large increase in the tobacco tax. It went from 39 cents a pack another 62 cents (91 cents). Virtually all studies have shown that youth smoking behavior is cost sensitive. So the ALA considers the SCHIP bill a win-win for children’s health by making it more affordable for the poorest families and helping to prevent further ill health.

While we are talking about tobacco control, let’s talk about talking about tobacco control:

Another issue we touched on is the idea that tobacco control is no longer, as Sward put it “the third rail” of American politics, and that it can now be openly discussed. In fact, for two decades, the ALA has recognized that only the Federal Government can regulate tobacco, and that if it is treated as a drug, that properly belongs under the auspices of the FDA. John McCain sponsored legislation in the Senate to do that, and in 2004 it passed the House, but never became law. (DemFromCT, “Flu And You – Part VII,” DailyKos)

I expect to get the usual libertarian crap about an individual’s “right to smoke” and the nanny state nonsense, but the whining on the margin excepted, things have changed dramatically. It wasn’t that long ago that Big Tobacco and their advertising money ruled the airwaves and all other mainstream media. They still have a remarkably sophisticated PR operation, and many of these libertarian-looking arguments are subtly or not so subtly encouraged by their invisible hand. That’s not to say many who put these arguments forth are knowingly in league with the tobacco lobby’s merchants of death, but they are certainly being used and manipulated by them.

If a person decides on the basis of full information (including the likelihood of addiction and fatal illness), I am not in favor of preventing them — as long as they don’t jack up my insurance premiums or harm me or my family with their side stream smoke. If it’s truly their choice, it’s also their responsibility and I don’t want to pay for it. They are on their own. I feel the same way about marijuana and alcohol. Users may be foolish (or use these products foolishly), but they aren’t criminals. But full and clear knowledge also means that Big Tobacco cannot target young people or fraudulently trick others into believing smoking will benefit them socially or manipulate their product to make it even more addicting. And the true cost of cigarettes must be part of the price, not externalized for me and the rest of society to pay for. The cigarette tax is one way to do that.

There’s lots more in Dem’s weekly public health read, including information on current legislative plans to bring tobacco under the FDA (an initiative of John McCain’s in the last congress that failed but will come up again). DailyKos is one of the biggest blogs in the know universe. I’m grateful that public health has gotten a regular place on its front page. Keep it up!

Comments

  1. #1 Ann P.
    February 23, 2009

    You could also say the same thing about obesity….and I don’t want to pay for THAT. Obesity is becoming a bigger problem than smoking. Smoking is on the decrease and obesity and overweight is on the increase. So when people eat themselves into obesity and acquire Typ2 diabetes and then get disabled, a lot of taxpayer monies end up paying for this through MEDICAID/MEDICARE, since obesity and Type 2 diabetes are linked to poverty. Actually smoking is linked to poverty as well.
    A recent ruling found that a diabetic patient was protected under the ADA for disability. There are an estimated 24 million people with diabetes in the U.S. and this number is growing along with obesity (they are termed twin epidemics) …who is going to pay for this?:
    http://seattletimes.nwsource.com/html/health/2008743449_diabetes14.html?syndication=rss
    Contrary to popular belief, smokers don’t clog up the health care system with their ailments (they die off). Smokers, based on economic analyses are actually a net savings to society since they pay into social security etc then usually don’t live long enough to collect much. See Viscusi (1992): State governments enjoy a net fiscal gain from each pack of cigarettes sold, even before excise taxes are taken into account. Because smokers tend to die young, he argues, governments incur lower nursing-home and health-care costs for smokers as a class. Instead obese people and people with diabetes are much more likely to clog up the healthcare system.
    I am not advocating smoking, but it also seems that making smokers pay for children’s health insurance is odd, since this implies that continuing such a program means we need to keep (some) people using tobacco?

  2. #2 floormaster squeeze
    February 23, 2009

    Sorry Ann P you are using some pretty discredited research and flawed logic (wouldn’t it just be cheaper to let preemies die than to save their lives and there increased chance of “clogging up the healthcare system”?).

    If you really cared about Obesity you would be for a host of regulatory (better and more accurate labelling, bans to certain ingredients, better public education, massive fines for adulterated product, etc.) But then we get into the absurd corporate liberties stuff and we usually find out who really cares about people’s health. I apologize if you do care but your construct “people eat themselves into obesity” when the entire corporate food culture makes that a much more complicated issue. The problem is when people grab on the most simplistic and politically convenient arm of the multicausal octopus.

    Your last point makes no sense as well. The goal is to make tobacco users pay for the full cost of their use (not the market price). If everyone stops buying cigarettes GREAT! (I admit some government officials may object to the loss of revenue in the short term for long-term benefits).

    The problem with “taxing” obesity is not, as you imply, with will but on the actual mechanism. If you place it on consumer products then non-obese people may enjoy products that ultimately make others obese. There are possible mechanisms (like April 15th weigh-ins) but then you get into serious libertarian problems.

    Usually, people complain disingenuously about alcohol. Alcohol overconsumption has massive health consequences as well but if you tax alcohol you also tax beneficial use. Yes, light alcohol use is healthier than none.

    Thank you for not smoking.

  3. #3 g336
    February 24, 2009

    First of all, let’s ditch the bad logic. Conflating all forms of tobacco with “cigarettes” is garbage. The risk associated with pipes and cigars are minimal: the worst of it is about 1 in 2,500 to 1 in 3,200 for oral cancer.

    Second, smokers should pay the relevant added costs for *their own* health risks, not be turned into convenient scapegoats on which to heap charges related to others’ risks. This little maneuver with SCHIP was classic: Oh The Children! Oh The Humanity! Make the Evil Smokers pay for The Innocent Children!

    Moralistic BS in the worst sort of way, the liberals’ equivalent of homosexuality.

    Third, the health risks of other lifestyle choices should also be chargeable back to those activities via health risk taxes, and all of this should be based on empirical data related to the items in question. Yes, that also means sporting goods used in extreme sports. For example I don’t want to pay for some idiot who gets his thrills climbing around on cliffs and might need his corpse to be expensively scraped off the rocks below by paramedics: mountain climbers ought to pay for that risk into the cost of their climbing gear and suchlike. I could care less whether the activity is Good and Wholesome or Bad and Evil, the bottom line is, if it rings up the bills, charge the costs back to the activity itself.

    Fourth, prohibitionism by the back door is still prohibitionism. Antismoking laws lead to increased tobacco consumption by people who smoke more “when they can”, when they expect to be unable to smoke where they’re going (such as out for a friggin’ walk on the sidewalk). Antismoking laws also cause some number of cigar and pipe smokers (low risk) to smoke some number of cigarettes (high risk) because cigarettes are comparatively fast, cheap, and convenient.

    Fifth, getting FDA in the act is a canard. If we’re going to do that with tobacco, we’d damn better well do it with alcohol and newly-legalized cannabis as well. Alcohol after all is implicated in half of all murders, suicides, and automobile fatalities. Smelling smoke while you’re walking down the street isn’t going to kill you, but some drunken fool (or cellphone-using fool for that matter) who swerves in traffic, just might.

  4. #4 Danimal
    February 24, 2009

    If a person decides on the basis of full information (including the likelihood of addiction and fatal illness), I am not in favor of preventing them — as long as they don’t jack up my insurance premiums or harm me or my family with their side stream smoke. If it’s truly their choice, it’s also their responsibility and I don’t want to pay for it.

    But pay for it you eventually will. The SCHIP replaces the CHIP bill and it to be paid for an increase in cigarette taxes. Well who smokes? I offer without proof, that most smokers are working poor blue collar workers. Those poor smoking workers will have to pay not only for their children, but for those poor who do not smoke. In the end it is taxing to poor to pay for the poor. If they quit smoking, then there is no money to pay for the bill. That is where they will have to go after someone else to get the funds. Anti-smoking advocate Dr. Michael Siegel has a write up about the bill entitled Congress Asks the Public to Smoke in Order to Fund Expanded Children’s Health Insurance. He states:

    First, does it make sense to tie a critical government program (children’s health insurance) to cigarette tax revenue, thus making continued levels of cigarette consumption necessary to maintain health insurance for children?

    If cigarette consumption falls significantly, there will – by definition – not be enough money in the SCHIP program to continue to cover all children in the program. Congress will either need to find an additional revenue source or cut children off from health insurance. This creates a strong incentive for the federal government not to take any action which might threaten to substantially decrease cigarette consumption.

    You see – this is the problem. The sustained provision of health insurance to children is now dependent upon continued high levels of cigarette consumption. The federal government literally does need smokers to continue to smoke, and at high amounts, to be able to provide health insurance to these additional 4 million children.

    In another post about the bill Dr. Siegel continues:

    Noting that the price of cigarettes in New York City will be over $10 per pack, which will drive many to quit or at least cut down on their smoking, the article notes that these decreases in cigarette consumption will lower the tax revenues in future years, thus threatening the solvency of the SCHIP program and ensuring that children will need to be kicked out of the program if the government doesn’t do something to maintain current levels of cigarette consumption or find alternative revenue sources.

    But, notes the article, if the government needs to find alternative revenue sources anyway than why not identify those sources now to create a fiscally sustainable program, rather than create the appearance of a solvent program, which appears to be somewhat deceptive.

    Another blogger, who Dr. Siegel linked to has this to say:

    Anybody with common sense knew that taxing tobacco use into extinction is not a sustainable way to fund government-provided health care. The taxes are too high, and the tax base is too small. But the liberals did it anyway, because the point wasn’t ever to have tobacco users fund the bill inevitably. The point was just to get the foot of government health care expansion in the door.

    Once they had the CHIP expansion in place they knew full well that it would never go away, even if tax revenues from tobacco users did. So while we Americans were sold on the idea of getting government-provided health care at the expense of a not-so-sympathetic demographic like smokers the reality is that we’re all going to end up paying for CHIP as soon as the smokers finally give up their freedom to smoke in the face of blatant economic prohibition.

    It was a bait-and-switch from the get-go.

    The point is that the government may well tax its revenue sourse (smokers) into extinction or it will have to get more people to smoke or tax some other undesirable habit. But I suppect in the end we will all pay for SCHIP.
    New t-shirt “Support Childrens Health Care – Smoke” or “I Smoke to Support Children Health Care”.

  5. #5 Marymary
    February 25, 2009

    >>Smelling smoke while you’re walking down the street isn’t going to kill you<<

    Anti-smoking laws(if that’s what you want to call them) are usually about indoor air, such as in workplaces and food establishments, not about prohibiting people from smoking outdoors. Yes, there are some places (such as hospitals and schools) that have become entirely smoke-free, but that decision is typically left to the individual business. Are there any smoke-free air laws or local ordinances that prohibit people from smoking while walking down the street?

    Where did this information come from?: “Antismoking laws lead to increased tobacco consumption by people who smoke more “when they can”, when they expect to be unable to smoke where they’re going (such as out for a friggin’ walk on the sidewalk). Antismoking laws also cause some number of cigar and pipe smokers (low risk) to smoke some number of cigarettes (high risk) because cigarettes are comparatively fast, cheap, and convenient.” Are there any independent studies that show those findings?

    I like this from floormaster squeeze: “The problem is when people grab on the most simplistic and politically convenient arm of the multicausal octopus.” Then g336 provides a post perfectly illustrating the point.

  6. #6 Danimal
    February 25, 2009

    I had a post in here yesterday that needs to be approved because of more then one link.

    @Marymary “Are there any smoke-free air laws or local ordinances that prohibit people from smoking while walking down the street?”

    Yes there are several places in California that ban outdoor smoking entirely. For example Calabasas bans virtually all outdoor smoking except for at shopping malls. Burbank is another city that bans outdoor smoking. You see smoking is not about health risks anymore the anti-smoking movement has become an anti-smoker movement. They want to ban smoking in cars (with children) present, homes with children present, stop employers from hiring smoker (even on private time), etc. That anti-tobacco crowd is doing everything to dehumanize smokers and that means that children should not even be allowed to see anyone smoking including in films.

  7. #7 revere
    February 25, 2009

    Danimal: Thanks for alerting me and commenting. I’ll go check to see what’s pending. I’m behind as I have been super busy at work.

  8. #8 Marymary
    February 25, 2009

    I stand corrected as to the facts you mention. The rest of it, no comment.

  9. #9 KW
    March 27, 2010

    @Danimal

    Banning smoking in cars with children is probably not so bad. After all, it is a confined space and I seem to recall reading that exposure to cigarette smoke is particularly damaging for young children and those at puberty.

    About the rest again, I reserve comment as well.

  10. #10 Thomas M.
    March 27, 2010

    Let’s cut the holier-than-thou crap about second-hand smoke’hurting me and my family.’ Unless you can find a study that demonstrates that a cigarette a day has a high likelihood of giving someone lung cancer, heart problems, or any of the other common ailments associated with cigarettes you have no business whatsoever claiming that second-hand smoke is going to harm you or anyone else, given that study after study shows that the maximum amount of smoke (and chemicals therein) inhaled by second-hand smoke in a smoke-heavy environment (say, a bar) is consistent with a fraction of a cigarette per day. Otherwise, barring cases of people with asthma issues, you’re just spewing forth dogma.

    g336 makes a valid point about pipes and cigars being pushed in with cigarettes when the comparison isn’t valid, though for some odd reason, pipe tobacco always seems to victimized by legislature for higher taxes when cigars typically are not. Likely because many of the congressman ARE cigar smokers and couldn’t bare to have their chosen form of tobacco use taxed. It’s also notable that if we’re going to use this ‘disingenuous’ alcohol comparison that it’s rather disingenuous to ignore the studies out there that indicate that moderate tobacco use (i.e. smoking pipes or cigars in moderation) leads to a longer life due to the relaxation benefits, just like moderate alcohol use. The two big problems are 1. Inhalation from cigarettes and 2. The inability of cigarette smokers to smoke in moderation, which is at least partially caused by the chemicals added to cigarettes to help with nicotine absorption. Emphasis on partially caused, by the way. I’ve noted that roll your own smokers (including those transitioning from factory cigarettes) smoke far less than those who buy Marlboro’s or whatever, but they still need a ‘nic hit’ but quite significantly, congress chose to raise the tax of RYO’s by 775% to keep them in line with the taxes on standard packs of cigarettes. Never mind that two and a half pack a day smokers manage to cut down to eight a day or less, and never mind that you’re not smoking rat poison that way, they needed to tax the safer alternative equivalently. This should really make one think hard about this Evil Tobacco Vs. Noble Government stand-point that’s being displayed here. Do a little research and find out who is actually behind it.

    That said, I think the notion that these bans encourage pipe and cigar smokers to smoke cigarettes is incorrect. There is some degree of similarity between the prices of cigars and cigarettes, however, pipe tobacco is currently much cheaper (unless the bill current in the ways and means committee in congress goes through which would give it the same draconian 775% tax as roll your own tobacco). There is also a distinctly different culture in place among pipe and cigar smokers and cigarette smokers. They tend to smoke those because it’s low risk and because it provides a satisfaction that cigarettes don’t for a variety of reasons that I won’t digress upon here. There is also a tendency among that culture to pity cigarette smokers for the health problems they’re going to suffer from, and the addiction problems that they face. These people aren’t likely to randomly start on cigarettes because they’re more convenient. Granted, I do meet the occasional pipe or cigar smoker who also smokes cigars, but I’ve not met a single one yet who didn’t start cigarettes before trying pipes or cigars. I’ve certainly not met anyone who started on pipe or cigars first and then switches to having cigarettes off and on to ‘smoke where they can.’

    As for the law about not smoking in the car with kids in there: I agree, this a fair law. The kids may have asthma issues, in which case it could do some harm, and even if not the case, cigarette smoking, being a high-risk activity, should be something that the kids approach as adults that are ready to decide if they want to take the risks involved or not. Seeing authority figures smoking in the car from a young age is likely to alter their mindset, for better or for worse. The problem is, whenever a law like this is advocated for (as it was in California and now is being advocated for in Britain) the advocates are typically not attempting to ban smoking in a car if children are present. They are attempting to ban smoking in a car, PERIOD, on the grounds that children or non-smoking passengers may be present at some point or another, and that children seeing you smoking in your car will somehow influence them to smoke even if they do not know you, which is a ridiculous imposition on peoples’ freedoms.

  11. #11 revere
    March 27, 2010

    Thomas M.: Without going into detail or asking why you would bar asthma (highly prevalent in children), the weight of the evidence on second hand smoke is fairly extensive and has been reviewed multiple times. More importantly, what kind of study are you asking for? Regarding second hand pipe and cigar smoke, it is likely at least as bad as cigarette smoke. Most studies of smoking do differentiate pipe and cigar smoking from cigarette smoking as you know, so I’m not sure what your point is. If you don’t like the idea of banning on some philosophical principles, that’s fine, but on the science, the evidence of harm is pretty good. The argument might be on the size of the harm but not the fact that it occurs. Whether the balance with your philosophical objections comes out one way or another is a different question and should be argued on those grounds.